Confusion

Delirium is the sudden onset of confusion characterised by:

• a disturbance of attention and awareness
• an acute onset with fluctuating progression of symptoms during the day
• a change in cognition or perception (hallucinations and/or delusions)

Delirium is common: 10% to 40% of patients admitted to hospital develop delirium during their admission. For patients in intensive care, this figure can even reach 80%. The confusion is temporary , but it can range from a few hours to a few days and even sometimes to a few weeks. Delirium is a frightening, unpleasant experience for both the patient and those in his or her environment. People with delirium often do not realise that they are in a confused state. Older patients are at a greater risk of developing delirium.

The causes of delirium can be understood as a disturbance in the body, such as:

• (Withdrawal from) substance abuse (alcohol, drugs, medication)
• A major operation
• Severe inflammation
• Pulmonary and heart diseases
• Metabolic disorders

People have a higher risk of developing delirium if they:

• have previously experienced delirium
• have memory problems or dementia
• have had a stroke
• use excessive alcohol or drugs
• have been admitted to Intensive Care for more than 48 hours

Symptoms that may occur to a greater or lesser extent in delirium are:

• Difficulty maintaining attention. Not everything seems to get through in conversations.
• Being restless and unable to sit still or, on the contrary, being sleepy and apathetic. Both extremes can alternate.
• Being forgetful. Things that were not mentioned are quickly forgotten again.
• Being convinced of certain untruths (delusions).
• Seeing objects, animals or people that are not there in reality (hallucinations).
• Feeling anxious and reacting angrily or aggressively.

Symptoms are not constant, but the confusion usually increases in the evening and at night.

Delirium is treated by removing the cause or trigger. To reduce the symptoms of delirium, drugs are sometimes administered. It may be necessary to immobilise the patient (e.g. to prevent the patient from falling out of bed, removing infusion tubes or injuring themselves). Of course, this drastic decision is always discussed with a relative or family member as soon as possible.

The presence of a familiar person can help calm a person experiencing delirium. Other tips for how visitors can deal with patients:

• If you visit and a patient reacts unusually, tell him or her who you are and why you have come. Repeat as necessary.
• Explain why he or she is in the hospital.
• Place a calendar in the room. Identify the day and place.
• Speak in clear short sentences and ask simple questions.
• Do not engage with the delusions or the things he or she sees or hears that are not there. Do not contradict the person, but make it clear that your perception is different. If this has no effect, stop your attempts. Stay calm.
• Visitors are important, but preferably not too many people at once. Only sit on one side of the bed. This makes it less confusing for the patient.
• Avoid whispering. After all, this can arouse suspicion.

Latest publication date: 02/08/2024
Supervising author: Dr Desimpelaere Patrick